Robert Wayne Blackburn, PHARM.D.,M.B.A.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

30586 Issued in CA

Practice address

1068 E 14TH St
San Leandro, CA 94577-3731

Phone

(949) 735-5256

Fax

(949) 643-9477

NPI assigned

Feb 24, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration, Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1386610855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25515 LONE PINE CIR",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926535847",
            "telephone_number": "949-735-5256",
            "fax_number": "949-643-9477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 E 14TH ST",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945773731",
            "telephone_number": "949-735-5256",
            "fax_number": "949-643-9477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "ROBERT",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.,M.B.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "30586",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "CA",
            "license": "30586",
            "primary": true
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NV",
            "license": "06648",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jane Elizabeth Blachnitzky, LMFT
• Erin Black
• Quinn Blackledge
• Sydnie Blackwood
• Linda Blaine
• Adena Blair, RN
• Andrew Blair

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.